title: Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy.
abstract: BACKGROUND
  This study was performed to investigate the role of surgery in patients with gastric cancer and distant metastases who had received systemic chemotherapy.
  
  
  METHODS
  Patients with newly diagnosed gastric cancer and synchronous distant metastases who had received chemotherapy (n = 274) were categorized into 3 groups according to the surgical treatment rendered: complete gross resection of both primary and metastatic sites (group A; n = 42); debulking gastrectomy (group B; n = 47); and chemotherapy without debulking (group C; n = 185).
  
  
  RESULTS
  The median overall survival of all patients was 11.8 months. The median overall survival and 3-year survival rates were 28.0, 15.5, and 9.0 months and 42.8, 8.1, and 3.5% in groups A, B, and C, respectively. In group A, patients with peritoneal seeding, intra-abdominal distant lymph nodes, or ovarian or hepatic metastases underwent complete gross resection, and 12 (29%) were disease-free at the time of the last analysis (median follow-up duration, 29.1 months). On multivariate analysis, the adjusted hazard ratios for death were 0.27 (P < 0.001) and 0.64 (P = 0.024) for groups A and B, respectively, as compared to group C.
  
  
  CONCLUSIONS
  Our study suggests survival benefits of debulking gastrectomy or gastrectomy plus metastasectomy in gastric cancer patients with distant metastases receiving systemic chemotherapy. Prolonged disease-free survival was observed after complete resection (gastrectomy plus metastasectomy) that may lead to cure in some patients. Well-designed prospective trials of the role of multidisciplinary approaches combining chemotherapy and surgery are needed to confirm the observations of our study.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Ki Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Keun-Wook
authors.initials: KW
authors.lastname: Lee
authors.forename: Sun Kyung
authors.initials: SK
authors.lastname: Baek
authors.forename: Hye Jung
authors.initials: HJ
authors.lastname: Chang
authors.forename: Yu Jung
authors.initials: YJ
authors.lastname: Kim
authors.forename: Do Joong
authors.initials: DJ
authors.lastname: Park
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyung-Ho
authors.initials: HH
authors.lastname: Kim
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000628:therapy*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents